Medical Necessity

Latest Headlines

Latest Headlines

Insurers push back against docs' 'Rolls Royce' treatments

As insurers increasingly deny treatment provided to members that they deem isn't medically necessary, some industry experts worry how there is no specific standard in the Affordable Care Act that states who determines what is a medical necessity, reported the  Los Angeles Daily News.

RACs recoup $745M in overpayments

Medicare RACs recovered $744.8 million in overpayments during the first quarter of fiscal year 2013, putting the program at more than $3 billion in recoupments since October 2009.

3 RAC targets to watch for

Auditors go where the money is. If you know where auditors are most likely to look, you can better fend off their attentions.

HCA cardiac procedures under federal scrutiny

Hospital Corporation of America (HCA), the nation's largest for-profit hospital chain, is under federal scrutiny due to a pattern of aggressively implanting cardiac stents, The New York Times reported.

Medical necessity contentions are fueling more RAC denials

Hospitals reported $167 million worth of claims denied by Medicare Recovery Audit Contractors between the first quarter of 2010 and the first quarter of this year, although in many instances the

UnitedHealth's Ingenix to buy Executive Health Resources, make FQHC version of CareTracker EHR

It's been a busy last couple of weeks for Ingenix. As you may have read last week in FierceHealthcare, Ingenix, the health IT subsidiary of UnitedHealth Group (NYSE: UNH), on Wednesday announced

SPOTLIGHT: Documentation, evidence-based admission guidelines help hospitals fight payer audits

Post-payment audits by Medicare and private insurers often look at the medical necessity of admitting patients through hospital emergency departments and find that many patients should have been held

HFMA ANI 2009: News and advice from the RAC front

It's not enough that Medicare's Recovery Audit Contractor program is going into full swing--CMS is also making some changes as it steams into its national rollout. Here's an update on some of the